AB0760 Factors associated with the retention of secukinumab (SEC) in patients with psoriatic arthritis (PsA) in real world practice: Results from the retrospective FORSYA study
Authors: A. Ruyssen-Witrand, J. Lucas, E. Desfleurs, P. Claudepierre, M. Dougados, P. Goupille, C. Lukas, A. Saraux, A. Tournadre, D. Wendling
Journal: Annals of the Rheumatic Diseases (2022)

Background While data on real-life retention of SEC in patients (pts) with PsA is accumulating, there are no data on predictive factors for this retention. Objectives The primary objective of FORSYA study was to assess whether objective signs of inflammation (OSI) were predictive of SEC retention at 1 year. Methods French retrospective study collecting between October 2019 and September 2020 data from axSpA pts a) having initiated and received at least one dose of SEC between August 11 th 2016 and August 31 st 2018, b)with at least a one year follow-up period. Retention of SEC at 1 year was estimated by the Kaplan Meier (KM) method. OSI were defined by at least one of the following within the 3 months before initiation of SEC: CRP&gt; N, confirmed clinical dactylitis, confirmed clinical synovitis or ultrasonography power-Doppler positive synovitis except on MTP of first toe. Preselected factors at initiation of SEC retention at 1 year (≥1 OSI, age, sex, BMI, smoking status, axial feature, past or present psoriasis / uveitis / Inflammatory Bowel Disease (IBD) / active arthritis or synovitis, diagnostic delay, disease duration, SEC line of biologic therapy, SEC maintenance dose, concomitant csDMARD, concomitant oral corticosteroids, ≥1 comorbidity) were analyzed by multivariate cox model regression. Only variables with &lt;20% missing data were included in the model after imputation and stepwise selection (significance level for entering variables = 20%; for removing variables = 10%). OSI was forced into the model whatever its significance level or rate of missing data. Results In total, 475 pts (male: 40.2%, mean age: 51.9 ± 12.2 years, mean disease duration: 9.3 ± 8.6 years) from 48 centers were included in the analysis. At initiation of SEC, 62.2% of pts had ≥ 1 OSI and respectively 11.0%, 19.5% and 69.6% were in 1 st , 2 nd and ≥ 3 rd line (L) of biologic/targeted synthetic DMARD. The overall 1 year KM survival rate for SEC was 63% [95%CI: 59%-68%] and was numerically greater in 1 st L vs 2 nd and ≥3 rd L (82% [72%-93%], 62% [52-72%], 61% [56%-66%] respectively). The overall survival rates for PsA pts with or without OSI were 62% [56%-68%] and 71% [62%-80%]. In multivariate analysis, absence of OSI, longer disease duration and lack of prior exposure to anti-TNF inhibitors were associated with a better SEC retention at 1 year (Table 1). Table 1. Predictive factors of SEC 1 year retention of SEC identified by multivariate cox regression analysis (multiple imputation + Stepwise selection ) Predictive factors (* reference) HR [95% CI] p vs ref p type III At least one objective sign of inflammation No (N=175)* Yes (N=295) 1.46 [1.05; 2.02] 0.023 Disease duration (years) ≤ 7.2 years (N=241)* &gt; 7.2 years (N=229) 0.69 [0.51; 0.94] 0.017 Secukinumab treatment line 1 st L (N=50)* 0.015 2 nd L (N=92) 2.43 [1.17; 5.05] 0.018 ≥ 3 rd L (N=328) 2.72 [1.38; 5.36] 0.004 Interpretation for predictor: HR&gt; 1: the hazard of discontinuation at 1 year is X times higher in category vs reference. Conclusion The overall retention of SEC at 1 year in daily practice at the time of its launch in France was 63% for PsA patients and OSI, disease duration and prior exposure to TNF inhibitors were identified as predictive factors of SEC retention. Acknowledgements Authors thank all participating investigators, centers and patients. This study was financially supported by NOVARTIS Pharma France. Disclosure of Interests Adeline Ruyssen-Witrand Consultant of: honorarium fees from Novartis France, Julien Lucas: None declared, Emilie Desfleurs Employee of: Novartis, Pascal Claudepierre Consultant of: Honorarium fees from Novartis France, Maxime Dougados Consultant of: honorarium fees from Novartis France, Philippe Goupille Consultant of: honorarium fees from Novartis France, Cédric Lukas Consultant of: honorarium fees from Novartis France, Alain Saraux Consultant of: honorarium fees from Novartis France, Anne Tournadre Consultant of: honorarium fees from Novartis France, Daniel Wendling Consultant of: honorarium fees from Novartis France